Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy in persons with chronic low back pain

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Abstract Introduction: Chronic low back pain is a highly prevalent and burdensome health problem that is predicted to impact upon almost all individuals at some point in their lifetimes. Chronic back pain not only leads to negative consequences for individuals, such as reduced physical function and impaired quality of life, but also confers socioeconomic effects where absenteeism from disability is a major contributor to reduced productivity and social isolation. Numerous management options for chronic back pain are available, although there has been increasing interest in the use of manual therapies among physiotherapy research. Aim: This systematic review aimed to explore the effect of the McKenzie method in reducing pain and physical disability among patients with chronic low back pain. Methods: Databases of MEDLINE, CINAHL, AMED, PEDro and the Cochrane library were searched in July 2019. Studies were limited to publication in the last decade, randomised controlled design and English language. Articles were appraised using the principles of Critical Appraisal Skills Program (CASP) and the outcomes were analysed using narrative synthesis. Results/Discussion: A total of 8 studies were found to be eligible for review and their methodological strength was low to moderate. Narrative analysis identified three main themes related to outcome measures including; 1) pain severity, 2) physical function and 3) other clinical outcomes. Overall, the McKenzie method had a minor to modest positive effect upon pain and disability, although only 50% of studies supported this effect, whilst others demonstrated non-significant improvements in chronic back pain outcomes. The limited effect upon pain and disability may be related to the influence of non-physical factors upon patient’s psychological state, which are known to interact with and exacerbate pain pathways or the positive effects may simply reflect a placebo-type effect. Conclusion: This review does not recommend the routine use of the McKenzie method and awaits the outcome of future research, which should aim to conduct higher quality randomised trials of a longer duration of follow-up and those that are able to account for important confounders. At present, physiotherapists could consider the McKenzie method for patients who fail to respond to alternative management options.